Document 3:11 (2011-2012) The Office of the Auditor General’s investigation into rehabilitation in the health service was submitted to the Storting on 6 March 2012.
Through its budget propositions and the National Strategy for Habilitation and Rehabilitation for 2008-2011, the Ministry of Health and Care Services announced that the field of rehabilitation was to be strengthened.
At the same time, however, the available reports show a reduction in activity relating to rehabilitation. Activity measured in DRG points (a measure for treatment in the specialist health service, which is subject to activity-based financing) shows a reduction in all the four health regions. During the period 2008 to 2010, the proportion of patients with a right to necessary health care in the form of rehabilitation was reduced in three of four regions.
Significant changes have taken place in the organisation and design of rehabilitation services in recent years. It is not possible, however, to measure whether these changes have strengthened the rehabilitation field during the period 2005 to 2010.
In 2010, waiting times for physical medicine and rehabilitation patients varied from 44 days in the South-Eastern Norway Regional Health Authority to 75 days in the Central Norway Regional Health Authority. One per cent of the physical medicine and rehabilitation patients were granted a right to necessary health care at Telemark Hospital, while the proportion was 90 per cent at Helse Førde health trust.
- This shows that there are big differences in the prioritisation of rehabilitation patients, and it entails a risk that patients who have a right to necessary health care are not being given priority, the Auditor General says.
The health trusts' rehabilitation departments and private rehabilitation institutions believe that more than half of the patients who are discharged have a need for follow-up by the municipal health service. At the same time, 80 per cent of the municipalities believe that the specialist health service lacks information about what services the municipalities can offer. In the experience of several rehabilitation departments in the health trusts, the municipalities largely lack the competence and capacity required to follow up the measures recommended by the specialist health service. This particularly affects young patients, who often need more specially adapted rehabilitation services.
- There is a need for better competence in the municipalities and for more cooperation between the heath trusts and the municipalities, so that the individual patients can be given better treatment, Kosmo says.
All the involved parties in the health service agree that individual plans are a useful tool for providing good rehabilitation services. Patients who have an individual plan have experienced that this has made them more conscious of how they can contribute to their own rehabilitation process. Only 17 per cent of the patients have an individual plan, however. More active use of individual plans could result in better rehabilitation processes for more patients. Since 2001, a regulation has required the municipalities to have a coordinating unit. It is intended to contribute to providing a coherent chain of treatment for those with a complex and prolonged need for services. A fifth of the municipalities have still not established such a unit.
The Ministry of Health and Care Services states that a number of measures have been implemented to strengthen efforts in the field of rehabilitation.
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The deferral of public access to documents prepared by or for the Office of the Auditor General in connection with Document No 3:11 (2011-2012), cf. the Act relating to the Office of the Auditor General section 18 second paragraph, is hereby set aside.